A diet containing anti-inflammatory foods and active ingredients such as Curcumin, Resveratrol, Natural Salicylates (such as apricots, broccoli, thyme and rosemary) and Caffeine, and other anti-inflammatory diets such as Mediterranean diet characterized by a high intake of vegetables, legumes, fruits and nuts, whole grain/cereals, lean meat such as fish and unsaturated fats (such as olive oil) may be beneficial for reducing the symptoms and improving treatment outcomes in patients with myeloproliferative neoplasms such as Polycythemia vera. However, consumption of foods containing saturated fats or trans-fats and those that cause obesity such as red meat, processed meat, margarines, processed foods and fried crisps may result in increased burden of symptoms as well as risk of these diseases. Following anti-inflammatory diet, increased intake of fluids, staying away from tobacco, maintaining a healthy weight, adopting a physically active lifestyle and doing regular exercises are necessary to prevent or ease the symptoms or improve the treatment outcomes of myeloproliferative neoplasms including Polycythemia vera. Finally, it is really important to personalize nutrition to the specific cancer type and other factors such as lifestyle, body weight, food allergies, and ongoing medications, to get maximum benefits and stay safe.
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What are Myeloproliferative Neoplasms?
Myeloproliferative neoplasms (MPN) are a group of rare conditions that affect the bone marrow resulting in the excess production of red blood cells, white blood cells or platelets. Inflammation plays an important role in myeloproliferative neoplasms.
The six different types of Myeloproliferative neoplasms (MPNs) are :
- Polycythemia vera
- Essential thrombocythemia
- Chronic myelogenous leukemia
- Chronic neutrophilic leukemia
- Chronic eosinophilic leukemia
The type of myeloproliferative neoplasm may be based on the type of the blood cells which are being produced more. In this blog we will elaborate on one of these myeloproliferative neoplasms, called Polycythemia vera (PV), with details on its signs and symptoms, treatments and the studies related to the association of different diets/foods/supplements with Polycythemia vera.
What is Polycythemia Vera?
Polycythemia Vera is the most common type of myeloproliferative neoplasm. About 148,000 people are diagnosed with this disease in the United States. It is a rare disease in which too many red blood cells are produced making the blood thicker than normal, affecting its flow and resulting in blood clots/thrombosis. Polycythemia Vera patients may also experience elevated white blood cell counts and elevated platelet counts over time.
Polycythemia Vera occurs when a gene mutation such as JAK2 mutation occurs which impacts the production of a protein that aids in the blood cell production, however, the actual cause of the gene mutation is unknown. It is more common in adults between 50 and 75, though it can occur at any age. Men are more likely to be diagnosed with polycythemia vera, however, women may get this disease at an early age.
Polycythemia vera usually develops very slowly and may not show symptoms and hence may not get diagnosed in the early stages. If not treated, it can lead to life threatening complications such as blood clots leading to stroke, heart attack, or a block in an artery or a vein/thrombosis; enlarged spleen; peptic ulcers and inflammation in the joints. Arterial thrombosis due to increased blood thickness is the most common cause of death in patients with Polycythemia Vera.
What are the Symptoms of Polycythemia Vera?
In the early stages, many patients with polycythemia vera may not have any noticeable signs or symptoms though few patients might show symptoms such as headache, blurred vision, dizziness and fatigue.
Some of the symptoms of Polycythemia Vera include:
- Unusual bleeding – a nosebleed or bleeding gums
- Itchiness, especially after a warm bath or shower
- A feeling of pressure below the left ribs or fullness soon after eating and bloating/pain in left upper abdomen due to an enlarged spleen
- Weakness, dizziness and unexplained weight loss
- Double vision or seeing dark spots that come and go
- Difficulty in breathing especially when lying down
- Painful swelling of one joint, usually the big toe
- Reddened face like a sunburn
- Numbness, tingling, burning, or weakness in your hands, feet, arms or legs
Proper treatment can help ease the signs and symptoms of Polycythemia Vera.
What are the Treatments for Polycythemia Vera?
Treatment for polycythemia vera focuses on reducing the risk of complications, preventing symptoms, and treating any underlying causes. Some of the treatments used in patients with polycythemia vera include :
- Blood removal – involves removing about half a litre of blood at a time
- Different Medicines to slow down the production of red blood cells
- Treatments to reduce itching
- Medicines to prevent blood clots
What is the Role of Diet in Myeloproliferative neoplasms or Polycythemia Vera?
When it comes to cancers such as Myeloproliferative neoplasms including Polycythemia Vera, eating the right foods as part of the cancer patients’ diet is crucial. Since Polycythemia Vera and other Myeloproliferative neoplasms are chronic-inflammation driven cancers, designing a nutrition plan targeting inflammation may help to manage this disease. Inflammation may be modulated through different anti-inflammatory diets/foods. Based on in vitro studies and observational studies in humans, here are examples of some foods which have been shown to be good or bad, when it comes to Myeloproliferative neoplasms/Polycythemia Vera.
1. Curcumin may be beneficial for patients with Myeloproliferative neoplasms (MPN)
Curcumin is a key ingredient present in the Turmeric spice, with anti-inflammatory, antioxidant and anti-tumor properties. Most of the Polycythemia Vera patients have a mutation of the JAK2 gene in their blood-forming cells.
An in vitro study done by the researchers from the University of Turin and San Luigi Gonzaga Hospital in Italy highlighted that Curcumin induces apoptosis/cell-death in JAK2-mutated cells from JAK2(V617F) positive MPN patients, suggesting that curcumin could be explored as an alternative strategy for the treatment of patients with Myeloproliferative Neoplasms. (Jessica Petiti et al, J Cell Mol Med., 2019)
Hence, including Curcumin in the diet may be beneficial for patients with Myeloproliferative neoplasms such as Polycythemia Vera.
2. Resveratrol may have therapeutic potential against Myeloproliferative Neoplasms with JAK2(V617F) Mutation
Resveratrol is a naturally occurring polyphenol found in red wine, red grape skins, purple grape juice and mulberries with anti-inflammatory, antitumor, and antioxidant properties. An in vitro study done by the researchers from the Kanazawa University and Miyazaki University in Japan found that Resveratrol inhibited proliferation and induced apoptosis in JAK2(V617F) mutant tumor cells, as well as inhibited erythroid progenitor (self-renewing stem cells that give rise to red blood cells) colony formation in blood samples obtained from JAK2(V617F) positive polycythemia vera patients. The study also found that resveratrol improved the effectiveness of a selective JAK2 inhibitor in eliminating tumor cells with the JAK2 mutation. (Ly Quoc Trung et al, Mol Nutr Food Res., 2015)
Based on these findings, the researchers concluded that resveratrol may have therapeutic potential against myeloproliferative neoplasms (such as polycythemia vera) associated with JAK2 mutation.
Hence, including resveratrol rich foods in the diet may be beneficial for improving treatment response in patients with polycythemia vera, however, do not include resveratrol supplements as part of the diet without consulting your healthcare provider.
3. Mediterranean Diet may lower the Symptom burden in Patients with Myeloproliferative Neoplasms
A Mediterranean diet is a diet characterized by a high intake of :
- Fruits and nuts
- Whole grain/cereals
- Lean meat such as fish and chicken and
- High ratio of unsaturated fats (from olive oil) to saturated fats (from red and processed meat, processed foods and fried foods)
Mediterranean Diet is considered as a healthy diet with the potential to combat inflammation and chronic diseases.
To find out whether patients with Myeloproliferative neoplasms (MPN) can adopt a Mediterranean diet if given dietician counseling and written curriculum, the researchers from the University of California developed a prospective 15-week study of 28 MPN patients who either followed Mediterranean diet along with Extra Virgin Olive Oil or the United States Dietary Guidelines for Americans (USDA). The study found that 75% of patients who followed the Mediterranean diet had a high Mediterranean diet adherence score compared to only 15–46% of the patients who followed USDA arm. The study also found that Myeloproliferative neoplasm patients with a high Mediterranean diet adherence score might be associated with a lower symptom burden. (Gajalakshmi Ramanathan et al, Cancers (Basel)., 2020)
Hence, following a Mediterranean diet may be beneficial for patients with Myeloproliferative neoplasms such as Polycythemia Vera.
4. Salicylic Acid may be beneficial in Reducing Thrombosis in Patients with Myeloproliferative Neoplasms such as Polycythemia Vera
Aspirin belongs to a family of compounds called the salicylates, including salicylic acid. A clinical study done by researchers from the Catholic University School of Medicine in Italy involving 518 patients with polycythemia vera highlighted that low-dose aspirin intake reduced thrombotic complications in patients with polycythemia vera who have no contraindications to such treatment by around 60%. (Raffaele Landolfi et al, N Engl J Med., 2004)
Hence, taking foods rich in natural salicylates including fruits such as apricots, vegetables such as broccoli, spices such as thyme and rosemary may be beneficial in reducing thrombosis. However, avoid taking aspirin tablets without consulting your health care providers.
5. Smoking Increases and Caffeinated Coffee intake reduces the Risk of Polycythemia Vera
Caffeine, a key ingredient of coffee is known to have antioxidant and anti-inflammatory properties.
In a population based study called the NIH-AARP Diet and Health Study including 463,049 participants who were aged between 50 and 71 years during recruitment, the researchers from the Yale School of Medicine in Connecticut, National Cancer Institute in Bethesda, Maryland, and the University of Texas evaluated the association between lifestyle factors and the risk of Myeloproliferative neoplasms (MPN). After a mean follow-up of 15.5 years, 490 MPN cases were reported including 190 with polycythemia vera (PV) and 146 with essential thrombocythemia (ET). (Nikolai A Podoltsev et al, Int J Cancer., 2020)
The study found that smoking might increase the risk of Myeloproliferative neoplasms (MPN) in women and caffeinated coffee intake might reduce the risk of polycythemia vera (PV).
Taking a cup of caffeinated coffee as part of the diet may be beneficial for reducing the risk of polycythemia vera.
6. High Sugar Intake may Increase the Risk of Polycythemia Vera
Based on analysis of data from the same study – the NIH-AARP Diet and Health Study -, the researchers also examined the possible associations between various dietary factors and the risk of Myeloproliferative neoplasms (MPN). The study found that a high intake of sugar is associated with an increased risk of polycythemia vera. (Nikolai A Podoltsev et al, Cancer Epidemiol Biomarkers Prev., 2020)
7. Obesity May Increase the Risk of Myeloproliferative Neoplasms and Total Symptom Burden in MPN Patients
- Researchers from the Zealand University Hospital, Bispebjerg University Hospital and University Hospital of Copenhagen at Rigshospitalet in Denmark; UT Health San Antonio MD Anderson Cancer Center, Incyte Corporation, UT Health San Antonio and Department of Hematology in the United States analyzed data from two large scale studies – the Danish Population-based Study, MPNhealthSurvey with 2044 participants and the International Fatigue Study with 1070 participants, to evaluate whether deviations from the normal BMI (Body Mass Index) in an MPN (Myeloproliferative Neoplasm) population are associated with higher symptom burden and reduced quality of life. The analysis of data from both the studies found that patients with Myeloproliferative Neoplasm who deviated from a normal BMI – the underweight and obese patients – had a significant increased Total Symptom Burden. (Sarah Friis Christensen et al, Cancers (Basel)., 2020)
- A study done by the researchers from the IDF Medical Corps and Tel Aviv University in Israel, and Harvard Medical School in the United States evaluated the association between overweight and myeloproliferative neoplasms (MPN). The study used data from a nationwide, population-based cohort study conducted between 1967 and 2011, involving 2516256 Israeli adolescents, who were aged between 16 and 19. After a mean follow-up of 19.86 ± 12.15 years, 433 MPN cases, especially chronic myelogenous leukemia, polycythemia vera, and essential thrombocythemia were reported. The study found that adolescent obesity might be associated with an increased risk of myeloproliferative neoplasms such as polycythemia vera. (Adi Leiba et al, Obesity (Silver Spring)., 2017)
To stay away from obesity one should avoid taking foods which is high in trans-fats and partially hydrogenated vegetable oils such as :
- Deep-fried items
- Red/processed meat
- Processed foods and fast foods
- Animal fats
- Refrigerated dough products
- Microwave popcorn
Based on these in vitro and observational studies, a diet containing anti-inflammatory foods and active ingredients such as Curcumin, Resveratrol, Natural Salicylates (fruits such as apricots, vegetables such as broccoli, spices such as thyme and rosemary) and Caffeine, and other anti-inflammatory diets such as Mediterranean diet characterized by a high intake of vegetables, legumes, fruits and nuts, whole grain/cereals, lean meat such as fish and chicken and unsaturated fats (from olive oil) may be beneficial for reducing the symptoms and improving treatment outcomes in patients with myeloproliferative neoplasms such as Polycythemia vera. However, consumption of foods containing saturated fats or trans-fats and those that cause obesity such as red and processed meat, margarines, processed foods and fried foods may result in increased symptom burden as well as risk of these life threatening diseases. Hence, consuming a healthy diet with emphasis on anti-inflammatory foods, increased intake of fluids, maintaining a healthy weight, staying away from tobacco, adopting a physically active lifestyle and doing regular exercises are necessary to prevent and ease the symptoms and treatment outcomes of myeloproliferative neoplasms including Polycythemia vera.
Cancer patients often have to deal with different chemotherapy side effects which affect their quality of life and look out for alternative therapies for cancer. Taking the right nutrition and supplements based on scientific considerations (avoiding guesswork and random selection) is the best natural remedy for cancer and treatment related side-effects.